Contraception – ARHP Commentary – Thinking (Re)Productively ✓ Solved

Contraception –5 ARHP Commentary – Thinking (Re)Productively Putting the man in contraceptive mandate

Contraception policies significantly impact reproductive health outcomes and gender equity in family planning. The recent emphasis on women's access to contraception under the Affordable Care Act (ACA) has not equally addressed men's reproductive responsibilities and options. This commentary argues for including comprehensive male contraceptive services, such as vasectomy and prospective male contraceptives, in reproductive health policies to promote gender equity, improve safety, reduce costs, and expand reproductive choice.

The ACA's contraceptive mandate, effective August 1, 2012, ensures no-cost access to contraceptive methods and sterilization services for women, yet it notably excludes coverage for male sterilizations like vasectomy and emerging male contraceptive methods. This omission perpetuates disparities, considering that only 10% of women rely on their partner's vasectomy, and female sterilization remains the predominant method, used by approximately 27% of women (Jones et al., 2012). Including male sterilization in health coverage is crucial, as vasectomy boasts similar efficacy to tubal ligation, but with fewer risks, lower costs, and higher safety profiles (Shih et al., 2011).

Comparative Efficacy, Safety, and Cost of Vasectomy versus Female Sterilization

Vasectomy is an effective, safe, and economical method of contraception. Data from the US Collaborative Review of Sterilization indicate the failure rates at five years post-procedure are comparable: 13.1 per 1,000 procedures for female sterilization and 11.3 per 1,000 for vasectomy (Peterson et al., 1996; Jamieson et al., 2004). Moreover, vasectomy carries significantly fewer risks; complications such as bleeding and infection occur in 0.043% of vasectomy cases compared to 1.2% of tubal ligations, with abdominal access further increasing generalized risks (Adams & Wald, 2009). The minimal invasiveness, office-based nature, and reduced anesthesia requirements make vasectomy better tolerated and more cost-effective, with median costs around US$700 compared to thousands for female sterilization (Levie & Chudnoff, 2005).

Economic and Accessibility Barriers to Male Sterilization

Despite its benefits, coverage for vasectomy remains limited, with approximately 25% of insurance policies excluding the procedure (Kurth et al., 2001). Even when covered, costs such as deductibles can pose barriers, with the average deductible exceeding the cost of vasectomy (Rae et al., 2012; Hatcher et al., 2011). For women, postpartum sterilization access is often delayed or restricted by hospital policies, religious considerations, or eligibility criteria, leading to unmet demand and higher rates of unintended pregnancies (Boardman et al., 2013; Wilcox et al., 1991). Ensuring no-cost coverage for vasectomy would facilitate equitable access and remove financial hurdles, potentially reducing unintended pregnancies and associated costs (Dailard, 2002).

The Need for Gender Equity in Reproductive Health Policies

Current reproductive health policies disproportionately place the burden of contraception on women, neglecting men's reproductive health needs and roles. This asymmetry not only limits reproductive options but also perpetuates gendered stereotypes about contraception responsibility. Evidence suggests that improved male involvement benefits reproductive health outcomes, reduces STI transmission, and promotes shared decision-making (Shih et al., 2013). Incorporating male contraceptive options into federal and state policies acknowledges reproductive rights as a human issue, fostering gender equality and shared responsibility in family planning.

Policy Recommendations for Including Male Contraceptive Services

To address these disparities, several policy measures are recommended:

• Amending the ACA's contraceptive mandate to explicitly include coverage for vasectomy and pilot programs for prospective male contraceptives.
• Encouraging the US Preventive Services Task Force to evaluate and recommend male contraceptive methods with at least a Grade B rating, which would mandate their inclusion in insurance coverage.
• States expanding coverage in their Essential Health Benefits, incorporating male reproductive health services, including vasectomy, into Medicaid and private insurance plans.
• Future federal reviews of Essential Health Benefits should explicitly include male fertility and contraception services, promoting nationwide access and equity.

Advocacy and Future Directions

Organizations like the National Health Law Program and professional associations are actively advocating for policy reforms to include male reproductive health services. Public awareness campaigns, social media, and provider education are vital in destigmatizing male contraception and highlighting its benefits. Additionally, supporting research into novel male contraceptive methods, such as hormonal injectables and reversible options, could diversify choices and improve acceptability (Dorman & Bishai, 2012). Policymakers should consider these evidence-based interventions to foster a more inclusive and equitable reproductive health landscape, thereby balancing reproductive responsibilities and promoting gender equality.

Conclusion

Reproductive health policies must evolve to recognize men's roles and responsibilities in contraception fully. Including coverage for vasectomy and prospective male contraceptives aligns with principles of gender equity, enhances safety, and can reduce costs for both individuals and the healthcare system. Policy amendments at federal and state levels, supported by advocacy and research, are essential steps toward a more inclusive approach to reproductive health, ultimately benefiting individuals, couples, and society at large.

References

• Burgess, S. (2010). FDA approves new indication for Gardasil to prevent genital warts in men and boys. FDA News Release.
• Adams, C. E., & Wald, M. (2009). Risks and complications of vasectomy. Urologic Clinics of North America, 36(3), 331–336.
• Boardman, L. A., Desimone, M., & Allen, R. H. (2013). Barriers to completion of desired postpartum sterilization. Rhode Island Medical Journal, 96(2), 32–34.
• Hatcher, R. A., Trussell, J., Nelson, A. L., et al. (2011). Contraceptive technology (20th revised edition). Ardent Media.
• Jones, J., Mosher, W., & Daniels, K. (2012). Current contraception use in the United States 2006–2010. National Health Statistics Reports, 60.
• Kurth, A., Bielinski, L., Graap, K., et al. (2001). Reproductive and sexual health benefits in private health insurance plans in Washington State. Family Planning Perspectives, 33(4), 188–192.
• Levie, M. D., & Chudnoff, S. G. (2005). Office hysteroscopic sterilization compared with laparoscopic sterilization: a critical cost analysis. Journal of Minimally Invasive Gynecology, 12(4), 318–322.
• Peterson, H. B., Xia, Z., Hughes, J. M., et al. (1996). The risk of pregnancy after tubal sterilization: findings from the US Collaborative Review of Sterilization. American Journal of Obstetrics & Gynecology, 174(4), 1161–1168.
• Shih, G., Dube, K., Sheinbein, M., et al. (2013). He's a real man: a qualitative study of the social context of couples' vasectomy decisions among a racially diverse population. American Journal of Men’s Health, 7(3), 206–213.
• Dorman, E., & Bishai, D. (2012). Demand for male contraception. Expert Review of Pharmacoeconomics & Outcomes Research, 12(5), 605–613.